Deep inferior epigastric artery perforator flap harvest after full abdominoplasty

Abstract

Abdominal scars are no longer a contra-indication for abdominal perforator flap harvesting. Few research data exists about the regeneration potential of the abdominal wall's perforator system. Therefore, previous abdominoplasty with umbilical transposition is an absolute contra-indication for a DIEaP-flap (deep inferior epigastric artery perforator flap). A 50-year-old patient required a breast reconstruction of the right breast, 10 years after an abdominoplasty with undermining of the superior abdomen and umbilical transposition. The patient was scheduled for a free lumbar artery perforator (LaP) flap. The preoperative computed tomography-angiography mapping showed nice lumbar perforators and to our surprise a good-sized DIEa perforator in the peri-umbilical region. The DIEa perforator on the right hemi-abdomen, consisting of two veins and one artery, was pulsatile and found suitable in size. A classical flap harvest and transfer was further performed. This case report is the first in which a dominant perforator is found in the area of undermining after a full abdominoplasty with umbilical repositioning. Further investigations regarding the nature and timing of re-permeation or regeneration of perforators after abdominoplasty are to be done. Nevertheless, we are convinced that with appropriate perforator mapping and a suitable plan B, previous abdominoplasty is no longer an absolute but a relative contra-indication for performing DIEaP-flap.

Isolated post laparoscopic DIEA injury in bilateral DIEP breast reconstruction

“…Several authors have reported successful outcomes in patients undergoing transverse rectus abdominis muscle (TRAM)/DIEP breast reconstruction following previous abdominal surgery 1–3. Johnson reported successful breast reconstruction using a delayed pedicled TRAM following previous laparoscopic ventral hernia repair due to concerns relating to flap vascularity 4.…”

Anatomic study of the profunda artery perforators by multidetector CT scanner and clinical use of the banana‐shaped flap design for breast reconstruction

“…The abdominal‐based deep inferior epigastric artery perforator flap (DIEP‐flap) remains the gold standard in autologous breast reconstruction 1 . Except for a few cases where a DIEP‐flap may still be possible, other donor sites should be explored in case of an insufficient (postabdominoplasty or too skinny patient) or unfavorable (previous liposuction, multiple abdominal surgeries) abdomen 2–4 …”